Tuesday, November 22, 2011

Fever Without Source in Children 3-36 Months: The Times They Are A-Changin’

It seems like only a decade or two ago when an infant or toddler presented to an emergency department with a fever without localizing source, they were automatically subjected to a CBC, U/A, blood and urine cultures and often a shot of ceftriaxone before being sent home (if not admitted). Nowadays, however, given the great vaccines that exist to prevent many of the more serious life-threatening infections from occurring, it appears that less is being done to children in this age group than in prior decades — but evidence to support that last claim has been lacking until this week, when a study by Simon et al. (doi: 10.1542/peds.2010-3855) of emergency evaluation of fever without source is released online in our journal. The authors used data from the National Hospital Ambulatory Medical Care Survey from 2006 - 2008 to identify emergency department visits in children 3 to 36 months of age who presented with fever without source. What was and was not done to these children — or should I say for these children — makes for an interesting read. One might expect that at least the majority of children might have their urine examined, but as the data show, that is not necessarily the case. Which factors are associated with diagnostic tests and treatment and which are not, should test your curiosity and result in downloading this important article: a snapshot of what is and is not being done to febrile children in emergency departments around the country.